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Having diabetes and BP problem. CT scan showed clots in brain. What are the implications with the findings?

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Neurologist, Surgical
Practicing since : 1996
Answered : 146 Questions
Dear Doctor,

My mother recently had a stroke to right side. She is getting better now. However, it was diagnosed from the CT scan of her brain that there were clots and these were the findings:

Left ICA (cervical part) is completely occluded.
A soft plaque noted in the posterior wall of the right bulb extending into the proximal ICA, causing <50% stenosis.
Hypodensity in the left frontal location - acute infarct Left MCA territory

Pre-health conditions.
She is diabetic and has blood pressure. Blood pressure is always under control, but her sugar levels keep fluctuating. She is gastric problem, as such she cannot digest all kinds of foods.

Please advise as to what are the implications with the current scan findings? Can this blockage be correct via surgical procedure? Is it advisable to have surgery with her given health conditions. What are the repercussions if these blockage in arteries are left "as-is"

Currently the physician has put her on "anti-clot" medication, which he has advised that she should take it life long. I have also enclosed the list of medications she is currently been prescribed.

Please give us the direction by providing answers to my above questions.

Thanks and Regards,
Posted Tue, 28 Aug 2012 in Stroke
Answered by Dr. Praveen K Nath 14 hours later

Thanks for the query.

Let me first wish you a speedy and complete recover of your mother.

I have gone through the details. It seems she has suffered a left middle cerebral artery (MCA) infarct with ipsilateral left internal carotid artery (ICA) blockage. In this context I suggest the following:

1. Continue with her present medications as given in the prescription. It is appropriate.

2. Follow a good diet as advised by her doctor/dietician. The diet needs be to low in fat and low in salt.

3. Go for a complete workup for stroke viz. LIPID PROFILE / 2D ECHO / REPEAT CAROTID DOPPLER / ECG / COMPLETE CARDIOLOGY CHECKUP / MRI BRAIN WITH DIFFUSION PROTOCOL / COMPLETE BLOOD COUNT / BLOOD SUGAR / HBA1C, etc. I hope all these test have been done by your doctor.

4. IF LEFT ICA BLOCKADE persists on repeat Doppler study, then carotid / vertebral angiography (IADSA) may be tried to see actual lumen & flow. Carotid angioplasty is needed only in few cases (as your mother has ipsilateral infarct).
If repeat Doppler shows improvement then no active intervention is required except medications & physiotherapy / diet control.

In brief, at this point of time, I do not suggest active intervention. Continue her current treatment as advised by your doctor. We may plan a repeat Doppler during her follow up visits with her doctor. Surgery / carotid angioplasty will rarely be needed.

I hope this answers all your queries. Feel free to contact me for any further query.

Best wishes for a speedy recovery
Dr. Praveen K Nath XXXXXXX Consultant Neurosurgeon
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